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Published on: February 26, 2013
Impact of Atrial Fibrillation on Coronary Blood Flow: A Systematic Review
George E Kochiadakis1, Eleftherios M Kallergis1
1Department of Cardiology, University Hospital of Heraklion, Crete, Greece.
Insights
Atrial fibrillation (AF) can cause myocardial ischemia symptoms by impairing coronary blood flow and reserve, even without coronary artery disease. This mismatch between blood supply and demand poses risks beyond patients with existing heart conditions.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Patients with atrial fibrillation (AF) often exhibit symptoms of myocardial ischemia.
- These symptoms can occur even without significant coronary artery disease (CAD).
- Myocardial perfusion and perfusion reserve abnormalities are implicated in AF-related ischemia.
Purpose of the Study:
- To investigate the relationship between atrial fibrillation and myocardial perfusion.
- To understand the impact of AF on coronary blood flow and vascular resistance.
- To elucidate the mechanisms behind reduced coronary flow reserve in AF patients.
Main Methods:
- Analysis of human and experimental studies on coronary hemodynamics during AF.
- Assessment of coronary artery blood flow and vascular resistance changes in AF.
- Evaluation of myocardial metabolic demand versus supply during irregular heart rhythms.
Main Results:
- Coronary artery blood flow increase during AF is less than expected.
- Coronary vascular resistance does not decrease sufficiently during AF.
- AF diminishes coronary flow reserve, particularly in the subendocardium, due to increased myocardial resistance.
Conclusions:
- A mismatch exists between coronary blood flow and myocardial metabolic demand in AF.
- Irregular ventricular rhythm in AF plays a significant role in reduced coronary flow reserve.
- These perfusion abnormalities have potential adverse consequences for a broader patient population, not limited to those with CAD.
Abstract:
Patients with atrial fibrillation (AF) frequently present with symptoms suggestive of myocardial isch- aemia, even in the absence of significant CAD, that seem to be attributable to abnormalities of myocardial perfusion and perfusion reserve. According to the results of recent human and previous experimen- tal studies the increase in coronary artery blood flow during AF is smaller, while the coronary vascular resistance during the arrhythmia does not decrease as much as we would expect, suggesting a mismatch between coronary blood flow and myocardial metabolic demand. AF itself diminishes coronary flow reserve, especially in the subendocardial layer, partly as a result of the increase in the myocardial com- ponent of coronary vascular resistance, and it is possible that irregular ventricular rhythm may play an important role. The mismatch of coronary blood flow and myocardial metabolic demand, especially in view of the severe reduction in coronary flow reserve, may have deleterious consequences that are not limited to patients with CAD.
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